Stephen A. Pearlman

Infective Endocarditis in the Premature Neonate

We describe a series of 11 high-risk neonates with infective endocarditis (IE) in this retrospective review. Previously IE has rarely been diagnosed in newborns and is usually fatal. The frequency was 4.3 cases per 100 patients. Five patients survived. Microorganisms included gram positives such as S. aureus and coagulase-negative Staphylococcus, gram negatives such as Klebsiella pneumoniae, Enterobacter cloacae, Enterococcusfaecalis, Serratia marcescens, and Acinetobacter calcoaceticus. Echocardiographic location of the lesions showed four left sided, five right sided, and two bilateral. We conclude that IE may be more common than previously described. Prompt diagnosis and treatment led to survival in 45% of our patients. Prospective studies are needed to identify patients at risk and to establish the true incidence of IE in high-risk neonates.

Multicenter Study To Determine Antibody Concentrations and Assess the Safety of Administration of INH-A21, a Donor-Selected Human Staphylococcal Immune Globulin, in Low-Birth-Weight Infants

ABSTRACT Nosocomial or late-onset sepsis is a common complication among premature infants, with a frequency inversely correlated with birth weight. Increased susceptibility to infection is due in part to an immature humoral (antibody-mediated) immune response. This study investigated the pharmacokinetics (PKs) and safety of a donor-selected specific intravenous immune globulin (IVIG) preparation, INH-A21 (Veronate), for prevention of sepsis in premature infants. Thirty-six infants weighing between 500 and 1,250 g during the first postnatal week were eligible to begin a series of up to four intravenous infusions of 500 or 750 mg/kg of body weight INH-A21. Blood samples were analyzed for antibodies against the Ser-Asp dipeptide repeat G (SdrG) and clumping factor A (ClfA) surface proteins of staphylococci. Sparse sampling and population PK analyses were performed to derive PK parameters. Following administration of the 500- and 750-mg/kg doses, the estimated average steady-state levels of anti-ClfA were 6.1 U/ml and 9.2 U/ml, respectively, and those of anti-SdrG were 5.2 U/ml and 7.7 U/ml, respectively. The elimination half-lives for anti-ClfA and anti-SdrG were 719 h and 701 h, respectively, and the clearances were 0.18 ml/h and 0.21 ml/h, respectively. In the final model, the values of the PK parameters were independent of gestational age. Both doses of INH-A21 were well tolerated, and the safety profile was similar to those of other IVIG preparations. These results suggest that a shorter dosing interval should be utilized between the first and second doses to achieve and maintain higher titers of anti-ClfA and anti-SdrG antibodies. Further studies examining INH-A21 for the prevention of late-onset sepsis in infants within the weight range studied are warranted.

Cranial Sonography in Very-Low-Birth-Weight Infants: Do All Infants Need to Be Screened?

The objective of the study was to develop clinical screening criteria to diagnose infants with intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL). We performed a case-control investigation of two cohorts of very-low-birth-weight infants (n=505, combined cohorts). Univariate and multivariate analyses were performed from data obtained in cohort 1 to develop screening criteria for IVH and cystic PVL. The screening criteria were then applied to cohort 2. The screening criteria for IVH had a sensitivity of only 51 %, a specificity of 62%, a positive predictive value of 31 %, and a negative predictive value of 79%. Screening criteria for cystic PVL had a sensitivity of only 22%, a specificity of 58% a positive predictive value of 2%, and a negative predictive value of 95%. These data suggest that using clinical criteria to determine which infants should receive screening cranial sonography for IVH and cystic PVL would miss a substantial number of infants with these conditions. Clin Pediatr. 1999;38:503-509

Predicting Length of Hospitalization of Sick Neonates from Their Initial Status

It has been suggested that the estimated date of confinement (EDC) may be used to predict the length of hospital stay for sick newborns. We have found this method unreliable and designed the following study to develop a mathematical model to predict length of stay (LOS). We reviewed the records of 393 neonates. Statistical analysis was performed using multiple linear regression. The factors that reached statistical significance were birth weight (BW), gestational age (GA), and a combined respiratory score (RES). The RES was developed to quantify the degree of initial respiratory illness. Through this model we developed the following formula: loge (LOS) = 4.395 - 0.023 (GA) - 0.00054 (BW) + 0.0274 (RES). The R value is 0.78. The model predicts an LOS ±10 days in 73% of cases. Overall, this model yields a 29% improvement in predictability of LOS compared with a model which used EDC only. This formula may provide useful information for parents and caregivers of hospitalized neonates.

PERFLUORCARBON AS A VEHICLE FOR ENDOTRACHEAL EPIENEPHRINE IN PEDIATRIC PORCINE ARREST † 211

PERFLUORCARBON AS A VEHICLE FOR ENDOTRACHEAL EPIENEPHRINE IN PEDIATRIC PORCINE ARREST † 211

RED BLOOD CELL TRANSFUSION IN INFANTS < 1500g: PREDICTING WHO WILL BENEFIT FROM RECOMBINANT ERYTHROPOIETIN. 1724

RED BLOOD CELL TRANSFUSION IN INFANTS < 1500g: PREDICTING WHO WILL BENEFIT FROM RECOMBINANT ERYTHROPOIETIN. 1724

LATERAL CEREBRAL VENTRICULAR ASYMMETRY IS ASSOCIATED WITH GRADE III-IV INTRAVENTRICULAR HEMORRHAGE IN INFANTS < 1500g. 1319

LATERAL CEREBRAL VENTRICULAR ASYMMETRY IS ASSOCIATED WITH GRADE III-IV INTRAVENTRICULAR HEMORRHAGE IN INFANTS < 1500g. 1319